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HumanaChoice SNP-DE H5216-420 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H5216-420 (PPO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice SNP-DE H5216-420 (PPO D-SNP) in 2026, please refer to our full plan details page.
HumanaChoice SNP-DE H5216-420 (PPO D-SNP) is a PPO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Eastern, South Central, and Western Wisconsin. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice SNP-DE H5216-420 (PPO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
HumanaChoice SNP-DE H5216-420 (PPO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HumanaChoice SNP-DE H5216-420 (PPO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For HumanaChoice SNP-DE H5216-420 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $15.30. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $13900.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for HumanaChoice SNP-DE H5216-420 (PPO D-SNP)
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Drug Coverage
The HumanaChoice SNP-DE H5216-420 (PPO D-SNP) plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay when using standard pharmacies or preferred mail order services. If you use standard mail order, Tier 1 drugs carry a $10 to $30 copay, while Tier 2 drugs require a $20 to $60 copay. For Tier 3 preferred brand and Tier 4 non-preferred drugs, you will pay a 25% coinsurance across all standard pharmacy and mail order options. Tier 5 specialty drugs also require a 25% coinsurance for a one-month supply.
Additional Benefits
The HumanaChoice SNP-DE H5216-420 (PPO D-SNP) offers comprehensive coverage for core medical services, generally requiring a 20% coinsurance and no copay for primary care, specialists, outpatient hospital services, and diagnostic tests. Inpatient hospital stays require a copay of $2,230 per acute stay and $2,080 per psychiatric stay, while home health care is fully covered with no copay or coinsurance. Skilled nursing facility care is also available, featuring no copay for the first 20 days of your stay. This plan also includes valuable supplemental benefits to help manage your everyday health costs. Members benefit from dental coverage with no copay and no coinsurance up to a $5,000 annual limit, alongside routine vision and hearing services that feature no copay. Additionally, the plan covers up to 30 one-way transportation trips per year, over-the-counter items, and chronic illness meals with no copay or coinsurance.
Inpatient Hospital See details
HumanaChoice SNP-DE H5216-420 (PPO D-SNP) covers inpatient acute hospital stays with a $2,230 copay per stay and inpatient psychiatric stays with a $2,080 copay per stay, both with no coinsurance and requiring prior authorization. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice SNP-DE H5216-420 (PPO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, and outpatient substance abuse services, with no copay and 20% coinsurance. Outpatient blood services are fully covered with no copay and no coinsurance, although prior authorization is required for most outpatient care.
Partial Hospitalization See details
HumanaChoice SNP-DE H5216-420 (PPO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
HumanaChoice SNP-DE H5216-420 (PPO D-SNP) covers ground ambulance services with a $335 copay and coinsurance, and air ambulance services with a 20% coinsurance and a copay, both requiring prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 30 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
HumanaChoice SNP-DE H5216-420 (PPO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a 20% coinsurance (up to $40) and no copay, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice SNP-DE H5216-420 (PPO D-SNP) covers primary care, specialist, therapy, and psychiatric services with no copay and a 20% coinsurance. Podiatry is not covered, and while some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
Preventive services are partially covered by HumanaChoice SNP-DE H5216-420 (PPO D-SNP) with no copay and no coinsurance for covered services, including annual physical exams, kidney disease education, and diabetes self-management training. However, additional preventive services such as fitness benefits, health education, nutritional/dietary benefits, and personal emergency response systems are not covered.
Hearing Services See details
HumanaChoice SNP-DE H5216-420 (PPO D-SNP) covers hearing services, including one annual routine exam with a 20% coinsurance and no copay, alongside unlimited fitting evaluations and OTC hearing aids with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance for up to two devices every three years, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Vision services are partially covered by HumanaChoice SNP-DE H5216-420 (PPO D-SNP), offering one routine eye exam yearly with no copay and 20% coinsurance up to a $40 limit, while other eye exams are not covered. Eyewear is also partially covered with no copay and no coinsurance up to a $350 annual limit for one pair of contact lenses or eyeglasses, but individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice SNP-DE H5216-420 (PPO D-SNP), which offers Medicare-covered dental with no copay and 20% coinsurance, and other covered dental services with no copay and no coinsurance up to a $5,000 annual maximum. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice SNP-DE H5216-420 (PPO D-SNP) covers Home Infusion bundled Services with prior authorization, featuring a $35 copay and 0% to 20% coinsurance for Medicare Part B insulin. Other Medicare Part B drugs carry no copay and 0% to 20% coinsurance, while chemotherapy and radiation drugs require a copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice SNP-DE H5216-420 (PPO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by HumanaChoice SNP-DE H5216-420 (PPO D-SNP) with 20% coinsurance and no copay for durable medical equipment, prosthetics, medical supplies, and diabetic services. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under HumanaChoice SNP-DE H5216-420 (PPO D-SNP) with a 20% coinsurance and require prior authorization. Members will pay no copay for lab services, diagnostic procedures, diagnostic radiology, and X-rays, though a copayment applies for therapeutic radiological services.
Home Health Services See details
Home health services are covered by HumanaChoice SNP-DE H5216-420 (PPO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice SNP-DE H5216-420 (PPO D-SNP) covers some cardiac rehabilitation services with no copay, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance. Prior authorization is required for the covered services.
Skilled Nursing Facility (SNF) See details
HumanaChoice SNP-DE H5216-420 (PPO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and while a prior three-day hospital stay is not required, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by HumanaChoice SNP-DE H5216-420 (PPO D-SNP), featuring acupuncture with no copay and 20% coinsurance (up to 20 treatments per year), as well as over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Highly integrated services for dual eligible SNPs are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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